Operative Technique Research Articles

Comparing surgical outcomes of subcutaneous-flap vs. subplatysmal-flap techniques in total open thyroidectomy: a cohort study

Introduction: Various minimally invasive open thyroidectomy techniques have been introduced in surgical centers worldwide, aiming to improve cosmetic outcomes. The conventional open thyroidectomy method involves creating a subplatysmal flap through a horizontal incision, which requires cutting the platysma muscle and anterior jugular veins. This study evaluates a modified open total thyroidectomy technique that uses a subcutaneous flap instead of a subplatysmal flap and compares its outcomes with those of the conventional method. Methods: This observational cohort study included 120 patients from 10 years experience of tertiary medical center. Outcomes were compared between the subcutaneous flap (MTT) group and the subplatysmal flap (CTT) group. Results: The modified technique increased the duration of surgery, with the flap type significantly affecting operation time (P = 0.016). However, there was no significant difference in hospital stay length between the two groups (P = 0.268). The incidence of hematoma and skin ischemia was lower with the subcutaneous flap. No significant differences were observed between the groups in terms of seroma formation, infection, keloid formation, or hypertrophic scars (P>0.05). Conclusion: The findings suggest that the subcutaneous flap technique is safe and does not make additional risks or complications. Additionally, it appears to offer advantages in specific outcomes.

Laparoscopic-assisted colostomy with anorectal malformation: friend or foe?

Abstract Purpose The standard management of anorectal malformations (ARM) without perineal fistula involves fecal diversion via a sigmoid colostomy. This report aims to describe our initial experience and evaluate the feasibility and benefits of laparoscopically-assisted loop colostomy in a neonate with ARM without perineal fistula, addressing the question of whether this minimally invasive approach offers advantages over traditional open techniques. Methods We report the case of a full-term male newborn with an imperforate anus. A laparoscopic-assisted loop colostomy was performed on the second day of life. Three trocars were used: a 5 mm umbilical port for the laparoscope and two 3 mm ports on the flanks. The surgical technique, including trocar placement, bowel mobilization, stoma creation, and closure, is described. The postoperative course and long-term outcomes were monitored over 17 months, including subsequent anorectoplasty and stoma closure. Results The laparoscopic approach provided superior visualization of pelvic anatomy, enabling accurate identification of the fistula and optimal stoma placement. Postoperatively, the patient exhibited early stoma function, rapid recovery, and no complications such as urinary tract infections or stomal issues. Follow-up procedures, including anorectoplasty and colostomy closure, were performed without incident. The patient remains healthy and complication-free at 17 months of age Conclusion Laparoscopic-assisted colostomy offers distinct advantages over the open technique, including reduced complications, improved recovery, and favorable cosmetic outcomes. This minimally invasive method represents a promising alternative for ARM management, aligning with modern pediatric surgical advancements.

Acceptance of Open Preperitoneal Repair in Inguinal Hernia Surgery Delphi-Consensus After an Anonymous International Survey Among European Hernia Society Members

IntroductionFor years, the Lichtenstein technique was the gold standard for open repair, but several open pre-peritoneal techniques have developed since the fifties of the 20th century that offer some benefits over the Lichtenstein technique in terms of post-surgical incidence of pain. Since the 2023 update of the International HerniaSurge Guidelines, open preperitoneal mesh techniques have been an acceptable alternative, providing available expertise and competence with at least equal results as Lichtenstein repair.AimThe aim of this project is to understand the views of surgeons regarding the approach to inguinal hernia repair and determine best practice principles for optimal surgical outcomes.MethodsUsing a modified Delphi method, a panel of experts developed 43 Likert scale statements across six key domains. These statements were used to develop an online survey distributed to surgeons in Europe involved in inguinal hernia repair. The threshold for consensus was set a priori at 75%.ResultsA total of 202 responses were received from surgeons involved in inguinal hernia repair over three rounds of survey. After the initial survey round, seven statements were revised and reissued for a further round. At the conclusion of the survey phase, 31 of the 38 remaining statements achieved consensus (of which 13 achieved ≥90% agreement). From these results, the panellists developed a set of 3 recommendations to help define principles for optimal approach to inguinal hernia repair. Accordingly Open preperitoneal techniques seems to be an alternative to Lichtenstein technique if expertise is available and should be included in a tailored concept. Knowledge of anatomy, Education and Training in open preperitoneal techniques is crucial for the acceptance of these techniques.ConclusionThe proposed set of recommendations provides some principles for surgeons to consider when selecting an approach to inguinal hernia repair, ensuring good patient outcomes in a practical and cost-effective manner.

A rare huge retroperitoneal accessory spleen mimicking right-sided sarcoma in a female patient: case report and review

Abstract Detecting retroperitoneal accessory spleen (AS) requires a high index of suspicion for proper and timely diagnosis. The AS can be found near the hilum of the spleen or wholly or partially embedded in the pancreatic tail, stomach, bowel, mesentery walls, or even in the pelvis. Left-sided retroperitoneal AS is common compared to the right-sided retroperitoneal location, which is very rare. The diagnosis of AS is not common preoperatively when investigating a mass in the other abdominal regions, and the surgical resection can thoroughly confirm the diagnosis. The management of AS is surgical excision through open, laparoscopic, or robotic-assisted techniques, depending on the patient status, the size and location of the mass, and the available treatment modality in the hospital. Here, we described a rare case presentation of a huge right retroperitoneal mass (AS) that was initially suspected as sarcoma and managed by laparotomy resection.

Comparison of outcome of fracture shaft of humerus treated conservatively with a functional brace versus open reduction and internal fixation.

Objective: To determine the frequency of non-union with functional brace versus operative techniques using open reduction and internal fixation in managing mid-shaft humerus fracture. Study Design: Randomized Controlled Trial. Setting: Department of Orthopedics and Traumatology, Lady Reading Hospital Peshawar. Period: 20th July 2023 to 20th January 2024. Methods: A total of 156 patients of both genders with mid-shaft humerus fractures were included in the study. Patients in group A were treated surgically. In group B patients were treated non-operatively. At the end of 12 weeks frequency of union/malunion was noted in both groups. Results: The age range in this study was from 18 to 60 years with a mean age of 39.666±12.78 years in Group A and a mean age of 42.423±10.66 years in Group B. Male gender was dominant in both groups (76.9% and 71.8%). Nonunion was observed in 2 (2.6%) patients in group A as compared to 15 (19.2%) patients in group B (P= 0.001). Conclusion: In conclusion, our study emphasizes that surgical intervention using ORIF is more effective than non-operative management.

Effectiveness of open glottis during second stage of labor on maternal and neonatal outcome among primigravid women- A quasi-experimental study.

This study evaluated the effectiveness of the open glottis breathing technique during the second stage of labor among 600 primigravida women, randomly assigned to either an open glottis group (n=300) or a closed glottis group (n=300). Participants in the open glottis group received training via 3D animated videos. Results demonstrated a significant impact on perineal integrity, with 20.7% of women in the experimental group reporting an intact perineum compared to just 1.7% in the control group. Additionally, the open glottis group experienced shorter labor durations and a decrease in severe neonatal asphyxia, as indicated by improved APGAR scores compared to the closed glottis group. Statistical analysis using the χ² test revealed a highly significant difference in perineal conditions between the two groups, with a χ² value of 65.7 (p < 0.000). The study also identified a significant association between maternal age, residence, and income with the reduction of perineal tears (p < 0.000). Overall, the findings suggest that the modified open glottis breathing technique effectively prevents perineal trauma, shortens the duration of the second stage of labor, and enhances neonatal outcomes. These results highlight the potential benefits of integrating this technique into labor management practices to improve maternal and neonatal health.

Comparison of Open and Close Exposure with Orthodontic Traction of Impacted Maxillary Canine in Orthodontic Treatments

Labial impactions make maxillary canines the most affected permanent teeth after third molars, at one third. Orthodontic advice is often needed for impacted canines. Objective: To compare the outcomes of open and close exposure with orthodontic traction of impacted maxillary canine in orthodontic treatments. Methods: In this comparative prospective cohort study 54 patients with labial impacted maxillary canine were included in this study. Study was conducted from Jan 2023- Jun 2023. Non-consecutive sampling technique was used. 27 patients were managed with open technique in group I and 27 patients with closed eruption technique in group II. The evaluation encompassed a comparison of two surgical exposure methods (open and closed) mobility, vitality, periodontal health, amount of impaction, length of orthodontic therapy, and postoperative discomfort. Results: Compared to the close eruption approach, the postoperative recovery time for open eruption was significantly greater (P &lt; 0.05). Patients reported comparable levels of postoperative discomfort; but, the closed eruption approach resulted in a more rapid resolution of that pain. The open eruption approach required less time during surgery on average compared to the closed eruption technique (P &lt;0.05). In a direct correlation with the amount of impaction, the overall length of orthodontic treatment was shown to be longer for deeper levels of impaction. Both methods produced canines with comparable levels of energy and movement. Conclusions: In this study, the closed eruption approach took longer but reduced postoperative pain faster. Orthodontic therapy took longer with deeper impaction. Closed eruption surgeries improve periodontal tissues surrounding guided erupted teeth.

Inadvertent Harm: An Institutional Analysis of Iatrogenic Vascular Injuries and Management

Iatrogenic vascular injuries are unintended complications arising from medical or surgical procedures, posing significant risks to patient outcomes. These injuries can result from various interventions, such as catheter placements and stent insertions, and may lead to serious complications. This study analyzes a series of iatrogenic vascular injuries encountered at our institution, focusing on their management and outcomes to enhance patient safety and procedural techniques. From September 1, 2022, to May 31, 2024, a total of nine patients (six males and three females) were treated for iatrogenic vascular injuries at our institution. The injuries resulted from various procedures, including catheter placements, endovascular interventions, and chemo port insertions. Management strategies included both endovascular and open-surgical approaches, with outcomes measured based on postoperative recovery, complications, and overall patient prognosis. The injuries involved a range of complications, including pseudoaneurysms, misplaced guidewires, and arterial damage. Endovascular techniques, such as stent placement and guidewire retrieval, were successfully utilized in four cases, while open surgical interventions were necessary in the remaining four cases to control severe bleeding and repair complex arterial defects. Postoperative complications were minimal, and all patients recovered well, with no mortality reported. Iatrogenic vascular injuries, though challenging, can be effectively managed with a combination of endovascular and open surgical techniques. The choice of approach should be dictated by the specific nature of the injury, aiming to minimize complications and ensure optimal patient outcomes. The findings from this case series underscore the importance of tailored management strategies in improving patient safety in vascular interventions.

Demographic Features of Acute Type A Aortic Dissection in a Heterogeneous Population of the Gulf Cooperation Council Region

Introduction: Type A aortic dissection (TAAD) management has markedly evolved in the last 20 years. However, the effect of patient demographics on TAAD presentation and outcomes has not been extensively studied worldwide. The aim of this study was therefore to investigate patient characteristics and their association with the perioperative parameters in a mixed population of the Gulf Cooperation Council (GCC) region. Methods: Consecutive patients presenting with TAAD (n=68) at a single centre between 2015 and 2021 were included. Seasonal variations in the occurrence of TAAD were described. Data on patient demographics, past medical history, presenting symptoms, operative techniques, postoperative complications, and in-hospital mortality were collected retrospectively and compared between patients with low (n=34) versus high (n=34) socioeconomic status (SES), and p&lt;0.05 was considered statistically significant. Results: Of the 68 TAAD patients (mean age at presentation, 48.2 ± 15.6 years), 79.4% were male. Admissions for TAAD peaked in spring with 25 cases, contrasting with the lowest number of 12 events in summer (36.8 versus 17.6%; RR 2.1; p=0.03). A total of 75% of patients were non-GCC nationals, of whom 31.4% originated from Western Asia/Levant, 25.5% from Southeast Asia, and 23.5% from the Indian subcontinent. Compared with the high-SES group, patients with low SES were numerically more likely to present with syncope (17.6% versus 2.9%; p=0.1) and featured a notable trend toward requiring more complex aortic reconstruction (88.2% versus 67.6%; p=0.08). Additionally, the low-SES group had numerically more prolonged intensive care unit and hospital length of stay, and a lower rate of previously diagnosed connective tissue disease (0 versus 11.76%, p=0.1). However, the rate of postoperative complications and in-hospital mortality were comparable between the groups. Conclusion: In this study from the GCC region, a significantly younger age at presentation with TAAD compared to Western data was identified, with considerable seasonal variation in incidence. In addition, patients with low SES presenting with TAAD appear to have increased resource usage during hospitalisation.

Impact of cardiac position, morphology and operative technique on long-term fontan outcomes in heterotaxy.

This study aimed to assess the outcomes of heterotaxy patients undergone the Fontan operation, focusing on morphological features and surgical techniques. Eighty-two consecutive heterotaxy patients who underwent the Fontan operation from 1985 to 2021 were compared to 150 patients with tricuspid atresia (TA) and 144 patients with hypoplastic left heart syndrome (HLHS). The Kaplan-Meier method and Cox proportional hazard model were used to analyze transplant-free survival and predictor of outcomes. The 20-year transplant-free survival rates were comparable between Right Atrial Isomerism (RAI, n = 45) and Left Atrial Isomerism (LAI, n = 37) (RAI vs LAI, 76% [95% confidence interval, 57-87%] vs 68% [47-82%], p = 0.22), although more pulmonary vein interventions at Fontan were needed in RAI. Surgical techniques included extracardiac conduit in 66%, intra-atrial conduit in 9%, lateral tunnel in 18% of the cases. Cardiac position and apicocaval juxtaposition did not influence outcomes, but the inferior vena cava (IVC)-contralateral PA Fontan was associated with 100% survival, while the IVC-ipsilateral PA Fontan at the cardiac apex showed a 67% [34-87%] survival rate at 20 years. In-hospital mortality was higher in heterotaxy (9.8% [5-19%]) compared to TA (1.3% [0.3-5.3%], p < 0.01) and HLHS (2.8% [1.1-7.3%], p = 0.02), with no early death after 2000 in any group. The 20-year transplant-free survival in heterotaxy (72% [59-82%]) was similar to that in HLHS (80% [69-87%], p = 0.11). Various routing techniques can be successfully applied to overcome anatomical challenges in heterotaxy. Despite higher in-hospital mortality, overall survival was similar to HLHS. RAI had comparable survival to LAI with more pulmonary vein interventions at Fontan.

Closed Preservation Rhinoplasty in the Mestizo Patient: Challenges and Techniques for Nasal Tip Support.

Closed preservation rhinoplasty continues to grow in popularity. Nevertheless, many surgeons remain wary of doing closed preservation rhinoplasty in certain patient populations. Mestizo noses have a thick soft-tissue envelope and weak nasal tip support. These inherent characteristics have led many surgeons to favor open structural techniques when addressing the tip in the Mestizo patient. The present article describes a set of techniques that have been successfully employed by the authors for maximizing tip support and definition when doing closed preservation rhinoplasty in a patient population for which structural techniques were once thought as the only viable option. A total of 417 primary rhinoplasty cases were studied retrospectively between January 2022 and December 2023. All the cases were performed using a closed approach and dorsal preservation of the soft-tissue envelope. All patients underwent one of the four types of surgical techniques for the tip area (Type I - 105 patients, Type II - 124, Type III - 181, and Type IV - 7). Of the total patients, 331 (79.3%) were female and 86 (20.6%) were male. Patient age varied from 15 to 66, with a median age of 23. Patients were followed for a period of six months to a year postoperatively. Seven patients underwent revision surgery (1.7%). Even with its various potential benefits, there is still apprehension about doing closed preservation rhinoplasty in certain patient populations. The authors present several techniques that have been successfully employed to maximize tip support and definition when performing closed preservation rhinoplasty in the Mestizo patient.

Evaluating Postoperative Morbidity and Outcomes of Robotic-Assisted Esophagectomy in Esophageal Cancer Treatment—A Comprehensive Review on Behalf of TROGSS (The Robotic Global Surgical Society) and EFISDS (European Federation International Society for Digestive Surgery) Joint Working Group

Background: Esophageal cancer, the seventh most common malignancy globally, requires esophagectomy for curative treatment. However, esophagectomy is associated with high postoperative morbidity and mortality, highlighting the need for minimally invasive approaches. Robotic-assisted surgery has emerged as a promising alternative to traditional open and minimally invasive esophagectomy (MIE), offering potential benefits in improving clinical and oncological outcomes. This review aims to assess the postoperative morbidity and outcomes of robotic surgery. Methods: A comprehensive review of the current literature was conducted, focusing on studies evaluating the role of robotic-assisted surgery in esophagectomy. Data were synthesized on the clinical outcomes, including postoperative complications, survival rates, and recovery time, as well as technological advancements in robotic surgery platforms. Studies comparing robotic-assisted esophagectomy with traditional approaches were analyzed to determine the potential advantages of robotic systems in improving surgical precision and patient outcomes. Results: Robotic-assisted esophagectomy (RAMIE) has shown significant improvements in clinical outcomes compared to open surgery and MIE, including reduced postoperative pain, less blood loss, and faster recovery. RAMIE offers enhanced thoracic access, with fewer complications than thoracotomy. The RACE technique has improved patient recovery and reduced morbidity. Fluorescence-guided technologies, including near-infrared fluorescence (NIRF), have proven valuable for sentinel node biopsy, lymphatic mapping, and angiography, helping identify critical structures and minimizing complications like anastomotic leakage and chylothorax. Despite these benefits, challenges such as the high cost of robotic systems and limited long-term data hinder broader adoption. Hybrid approaches, combining robotic and open techniques, remain common in clinical practice. Conclusions: Robotic-assisted esophagectomy offers promising advantages, including enhanced precision, reduced complications, and faster recovery, but challenges related to cost, accessibility, and evidence gaps must be addressed. The hybrid approach remains a valuable option in select clinical scenarios. Continued research, including large-scale randomized controlled trials, is necessary to further establish the role of robotic surgery as the standard treatment for resectable esophageal cancer.

Integration of on-board monitoring data into infrastructure management for effective decision-making in railway maintenance

Abstract Railway infrastructure is a crucial asset for the mobility of people and goods. The increased traffic frequency imposes higher loads and speeds, leading to accelerated infrastructure degradation. Asset managers require timely information regarding the current (diagnosis) and future (prognosis) condition of their assets to make informed decisions on maintenance and renewal actions. In recent years, in-service vehicles equipped with on-board monitoring (OBM) measuring devices, such as accelerometers, have been introduced on railroad networks, traversing the network almost daily. This article explores the application of state-of-the-art OBM-based track quality indicators for railway infrastructure condition assessment and prediction, primarily under the prism of track geometry quality. The results highlight the similarities and advantages of applying track quality indicators generated from OBM measurements (high frequency and relatively lower accuracy data) compared to those generated from higher precision, yet temporally sparser, data collected by traditional track recording vehicles (TRVs) for infrastructure management purposes. The findings demonstrate the performance of the two approaches, further revealing the value of OBM information for monitoring the track status degradation process. This work makes a case for the advantageous use of OBM data for railway infrastructure management, and attempts to aid understanding in the application of OBM techniques for engineers and operators.

Depressive, anxiety, and sleep disturbance symptoms in patients with obstructive sleep apnea: a network analysis perspective

BackgroundPatients with obstructive sleep apnea (OSA) frequently experience sleep disturbance and psychological distress, such as depression and anxiety, which may have a negative impact on their health status and functional abilities. To gain a more comprehensive understanding of the symptoms of depression, anxiety, and sleep disturbance in patients with OSA, the current study utilized network analysis to examine the interconnections among these symptoms.MethodsDepressive and anxiety symptoms were evaluated using the Hospital Anxiety and Depression Scale (HADS), and sleep disturbance symptoms were evaluated using the Pittsburgh Sleep Quality Index (PSQI). A total of 621 patients with OSA completed the questionnaires. The indices 'Expected influence' and 'Bridge expected influence' were used as centrality measures in the symptom network. The Least Absolute Shrinkage and Selection Operator (LASSO) technique and the Extended Bayesian Information Criterion (EBIC) were utilized to estimate the network structure of depressive, anxiety, and sleep disturbance symptoms. A Network Comparison Test (NCT) was performed to evaluate the differences between the mild to moderate OSA and severe OSA networks.ResultsNetwork analysis revealed that A6 (“Getting sudden feelings of panic”) had the highest expected influence value and D6 (“Feeling being slowed down”) had the highest bridge expected influence values in the networks. The NCT results revealed that the edge weights significantly differed between patients with mild to moderate OSA and those with severe OSA (M = 0.263, p = 0.008). There was no significant difference in global strength variation between the two networks (S = 0.185, p = 0.773).ConclusionsOur results suggest that the highest expected influence value and bridge symptoms (e.g., A6 and D6) can be prioritized as potential targets for intervention and treatment in patients with OSA.

Do modern orthopaedic trainees have sufficient exposure to open shoulder stabilization procedures?

Background: Arthroscopic stabilization and bone augmentation procedures have become common treatment options for anterior shoulder instability, while the use of open soft tissue stabilization procedures has declined. This study aimed to determine current trends in utilization of open soft tissue stabilization among shoulder surgeons and the relationship between procedure volume in practice and exposure as trainees. Methods: Out of the 1,115 American Shoulder and Elbow Surgeon members surveyed, 212 surgeons completed a questionnaire about exposure to open soft tissue stabilization techniques during training, practice patterns for shoulder instability, perceived skill with open soft tissue stabilization procedures, and opinions on the importance of these procedures. Statistical analyses correlated practice numbers, training exposure, and self-perceived facileness. Results: Out of the 212 surgeons who completed the survey, 71% (n=153/212) of respondents performed less than 25% of their stabilization procedures in an open manner. Sixty-seven percent (n=143/212) of respondents reported that less than 10% of their open procedures involved only soft tissue. The number of open soft tissue stabilization procedures performed in practice correlated with the number performed during residency (r=0.42; P&lt;0.001) and fellowship (r=0.46; P&lt;0.001). Eighty percent of respondents reported self-perceived facileness with open soft tissue stabilization which correlated with the number of procedures performed in practice (P&lt;0.001), residency (P&lt;0.001), and fellowship (P&lt;0.001). Half of respondents (51%; n=109/212) believed that procedure exposure was necessary for residents. Conclusion: Shoulder specialists perform a low volume of open soft tissue stabilization procedures currently. Exposure throughout training correlates with using these procedures in practice, and with surgeon confidence. Level of evidence: V

Regional Gene Therapy for Bone Tissue Engineering: A Current Concepts Review

The management of segmental bone defects presents a complex reconstruction challenge for orthopedic surgeons. Current treatment options are limited by efficacy across the spectrum of injury, morbidity, and cost. Regional gene therapy is a promising tissue engineering strategy for bone repair, as it allows for local implantation of nucleic acids or genetically modified cells to direct specific protein expression. In cell-based gene therapy approaches, a variety of different cell types have been described including mesenchymal stem cells (MSCs) derived from multiple sources—bone marrow, adipose, skeletal muscle, and umbilical cord tissue, among others. MSCs, in particular, have been well studied, as they serve as a source of osteoprogenitor cells in addition to providing a vehicle for transgene delivery. Furthermore, MSCs possess immunomodulatory properties, which may support the development of an allogeneic “off-the-shelf” gene therapy product. Identifying an optimal cell type is paramount to the successful clinical translation of cell-based gene therapy approaches. Here, we review current strategies for the management of segmental bone loss in orthopedic surgery, including bone grafting, bone graft substitutes, and operative techniques. We also highlight regional gene therapy as a tissue engineering strategy for bone repair, with a focus on cell types and cell sources suitable for this application.

White matter connections within the central sulcus subserving the somato-cognitive action network.

The somato-cognitive action network (SCAN) consists of three nodes interspersed within Penfield's motor effector regions. The configuration of the somato-cognitive action network nodes resembles the one of the 'plis de passage' of the central sulcus: small gyri bridging the precentral and postcentral gyri. Thus, we hypothesize that these may provide a structural substrate of the somato-cognitive action network. Here, using microdissections of sixteen human hemispheres, we consistently identified a chain of three distinct plis de passage with increased underlying white matter, in locations analogous to the somato-cognitive action network nodes. We mapped localizations of plis de passage into standard stereotactic space to seed fMRI connectivity across 9,000 resting-state fMRI scans, which demonstrated the connectivity of these sites with the somato-cognitive action network. Intraoperative recordings during direct electrical central sulcus stimulation further identified inter-effector regions corresponding to plis de passage locations. This work provides a critical step towards improved understanding of the somato-cognitive action network in both structural and functional terms. Further, our work has the potential to guide the development of refined motor cortex stimulation techniques for treating brain disorders, and operative resective techniques for complex surgery of the motor cortex.

Mid-term results of coronary artery bypass surgery assessment by multisliced CT scan at Dong Nai General Hospital

Introduction: Coronary artery bypass grafting is a major surgery that uses different grafts to bypass atherosclerotic lesions causing stenosis or occlusion of coronary arteries. There are two types of techniques: coronary artery bypass grafting with cardiac arrest and without cardiac arrest. MSCT 256 is a good means of assessing graft patency. Methods: Case series report, retrospective of patients undergoing coronary artery bypass surgery at Dong Nai general hospital. Patients who meet the selection criteria will have an MSCT 256 scan with contrast to evaluate the level of graft patency. Results: 40 patients were included in the study from May 2021 to August 2024. Average age is 62 years old, men account for 75% of patients. The average number of anastomoses was 3.05, the average surgery time was 243 minutes. The early mortality rate is 2.5%, early complications include acute myocardial infarction (2.5%), reoperation due to bleeding (2.5%), sternum infection (5%), and pneumonia requiring mechanical ventilation &gt; 24 hours. hours (10%). The medium-term mortality rate was 5.1%, with cardiovascular mortality. The coronary graft patency was good, there was 1 case of unclear image of the vein - obtuse artery - posterior descending artery bypass. Conclusion: Coronary artery bypass surgery at Dong Nai General Hospital has good mid-term results, showing the effectiveness of the program to transfer open heart surgery techniques from Cho Ray Hospital to Dong Nai General Hospital. Implementing this technique helps reduce the load on central hospitals and enhances the reputation of local teams. Coronary CT Scan helped assessing the patency of CABG in stable postoperative patients.

Osteonecrosis of the Humerus: Trends in Surgical Management of a Nationwide Sample From 2010 to 2021.

The humeral head is the second most common site for osteonecrosis but its epidemiology is poorly described. This study aimed to better understand its treatment in the United States by 1) evaluating total operative procedures with rates normalized to the annual surgical volume; 2) determining trends of non-joint preserving (shoulder arthroplasty) vs. joint preserving procedures; and 3) quantifying rates of operative techniques in different aged cohorts (<50 vs. ≥50 years old). A nationwide database was queried for patients with humeral osteonecrosis who underwent surgery between January 1st, 2010 and April 30, 2021, yielding 9,307 cases. Patients classified under non-joint preserving procedures included those who underwent shoulder arthroplasty (total and reverse) (N = 5,752) and hemiarthroplasty (N = 2,086). Joint preserving procedures included humeral head core decompression and arthroscopic débridement (N = 1,469). The percentage of patients annually managed by each operative procedure was calculated and normalized to the overall annual surgical population from our sample. Linear regression modelling was performed to evaluate trends/differences in procedural volume over time based on the type of procedure (joint preserving vs. non-preserving) and age cohort (under versus over 50 years old). P-values < 0.05 were significant. Within this nationwide sample, the number of procedures to treat shoulder osteonecrosis relative to all shoulder procedures was 0.85% (9,307/1,092,726). Overall, shoulder arthroplasty (total and reverse) was the most commonly performed procedure (N = 5,752; 61.8%), followed by hemiarthroplasty (N = 2,086; 22.4%), and core decompression/arthroscopic débridement (N = 1,469; 15.8%). Non-joint preserving comprised 7,838 procedures (84.2%), while 1,469 (15.8%) were joint preserving. On age group subanalysis, there were significantly more joint preserving procedures in patients aged <50 years (25.8% vs. 14.1%, P < 0.001). Core decompression/arthroscopic débridement as a proportion of all procedures in patients younger than 50 increased over the study period (22.1% to 35.6%, P = 0.035). Procedures used to manage humeral osteonecrosis comprise less than 1% of all shoulder surgeries. These procedures continue to be predominantly shoulder arthroplasty; however, the utilization of joint preserving procedures seem to be growing over time, notably in patients <50 years of age. Shoulder surgeons may use this data to better educate patients about treatment options during the decision-making process. Future studies should be aimed towards further characterizing patterns in the diagnosis and treatment of humeral osteonecrosis.

Comparative effectiveness of intraarticular injection of PRP and implantation of heparin-conjugated fibrin hydrogel in osteoarthrosis of the knee joint

Aim of the study. The article is devoted to the current trend of modern orthopedics – the surgical treatment of local full-thickness defects in the hyaline cartilage of the knee joint. This pathology is diagnosed in 5-10% of patients with diseases and injuries of the knee joint.Materials and methods. The authors of the article presented one of the most modern and available technologies for the restoration of cartilage defects – the implantation of Heparin-Conjugated Fibrin Hydrogel. This operation technique was used in 38 patients. The article presents the indications and technique of surgery, criteria for evaluating treatment outcomes.Results and discussion. Treatment outcomes in terms of up to 2 years were studied in 38 patients. Good treatment results were observed in 33 patients. In all cases, high-quality and regeneration of the cartilaginous surface of the femoral condyles was achieved.Conclusion. Analysis of the outcomes of treatment of patients after implantation implantation of Heparin- Conjugated Fibrin Hydrogel allows the authors of the article to recommend this technique for widespread use in clinical practice.